Key beliefs of hospital nurses’ hand-hygiene behaviour: Protecting your peers and needing effective reminders

Issues addressed: Hand hygiene in hospitals is vital to limit the spread of infections. This study aimed to identify key beliefs underlying hospital nurses’ hand-hygiene decisions to consolidate strategies that encourage compliance. Methods: Informed by a theory of planned behaviour belief framework, nurses from 50 Australian hospitals (n = 797) responded to how likely behavioural beliefs (advantages and disadvantages), normative beliefs (important referents) and control beliefs (barriers) impacted on their hand-hygiene decisions following the introduction of a national ‘5 moments for hand hygiene’ initiative. Two weeks after completing the survey, they reported their hand-hygiene adherence. Stepwise regression analyses identified key beliefs that determined nurses’ hand-hygiene behaviour. Results: Reducing the chance of infection for co-workers influenced nurses’ hygiene behaviour, with lack of time and forgetfulness identified as barriers. Conclusions: Future efforts to improve hand hygiene should highlight the potential impact on colleagues and consider strategies to combat time constraints, as well as implementing workplace reminders to prompt greater hand-hygiene compliance. So what? Rather than emphasising the health of self and patients in efforts to encourage hand-hygiene practices, a focus on peer protection should be adopted and more effective workplace reminders should be implemented to combat forgetting.

A coordinated voltage control approach for coordination of OLTC, voltage regulator, and DG to regulate voltage in a distribution feeder

Integration of small-scale electricity generators, known as distributed generation (DG), into the distribution networks has become increasingly popular at the present. This tendency together with the falling price of the synchronous-type generator has potential to give DG a better chance at participating in the voltage regulation process together with other devices already available in the system. The voltage control issue turns out to be a very challenging problem for the distribution engineers since existing control coordination schemes would need to be reconsidered to take into account the DG operation. In this paper, we propose a control coordination technique, which is able to utilize the ability of DG as a voltage regulator and, at the same time, minimize interaction with other active devices, such as an on-load tap changing transformer and a voltage regulator. The technique has been developed based on the concept of control zone, line drop compensation, dead band, as well as the choice of controllers' parameters. Simulations carried out on an Australian system show that the technique is suitable and flexible for any system with multiple regulating devices including DG.

Playing Monopoly™ with real estate students

This paper outlines the results from a study into the educational use of the board game Monopoly City™ in a first year real estate unit. This game play was introduced as a fun and interactive way of achieving a number of desired outcomes including: introduction of foundational threshold concepts in real estate education; introduction of problem solving and critical analysis skills; early acculturation of real estate students to enhance student retention; early team building within the student cohort; and enhanced engagement of first year students and, all in an engaging and entertaining way. Results from this two-stage research project are encouraging. The students participating in this project have demonstrated explicit linkages between their Monopoly City™ experiences and foundation urban economic and valuation theories. Students are also recognising the role strategy and chance play in the real estate sector. Findings from this project and key success factors are presented.

Validity of the geriatric depression scale and the collateral source version of the geriatric depression scale in nursing homes

Background Depression is a common psychiatric disorder in older people. The study aimed to examine the screening accuracy of the Geriatric Depression Scale (GDS) and the Collateral Source version of the Geriatric Depression Scale (CS-GDS) in the nursing home setting. Methods Eighty-eight residents from 14 nursing homes were assessed for depression using the GDS and the CS-GDS, and validated against clinician diagnosed depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID) for residents without dementia and the Provisional Diagnostic Criteria for Depression in Alzheimer Disease (PDCdAD) for those with dementia. The screening performances of five versions of the GDS (30-, 15-, 10-, 8-, and 4-item) and two versions of the CS-GDS (30- and 15-item) were analyzed using receiver operating characteristic (ROC) curves. Results Among residents without dementia, both the self-rated (AUC = 0.75–0.79) and proxy-rated (AUC = 0.67) GDS variations performed significantly better than chance in screening for depression. However, neither instrument adequately identified depression among residents with dementia (AUC between 0.57 and 0.70). Among the GDS variations, the 4- and 8-item scales had the highest AUC and the optimal cut-offs were >0 and >3, respectively. Conclusions The validity of the GDS in detecting depression requires a certain level of cognitive functioning. While the CS-GDS is designed to remedy this issue by using an informant, it did not have adequate validity in detecting depression among residents with dementia. Further research is needed on informant selection and other factors that can potentially influence the validity of proxy-based measures in the nursing home setting.

Senator Elizabeth Warren fights the White House over the secret Trans-Pacific Partnership #TPP #TPPA

In his visit to the G20 in Brisbane, President Barack Obama sought to promote his ambitious Pacific Rim trade agreement — the Trans-Pacific Partnership (TPP). He told an audience at the University of Queensland: We’ll keep leading the effort to realize the Trans-Pacific Partnership to lower barriers, open markets, export goods, and create good jobs for our people. But with the 12 countries of the TPP making up nearly 40 percent of the global economy, this is also about something bigger. It is our chance to put in place new, high standards for trade in the 21st century that uphold our values. So, for example, we are pushing new standards in this trade agreement, requiring countries that participate to protect their workers better and to protect the environment better, and protect intellectual property that unleashes innovation, and baseline standards to ensure transparency and rule of law.

The Lazarus effect: The (RED) campaign, and creative capitalism

"4,400 people die every day of AIDS in sub-Saharan Africa. Treatment exists. In about 60 days, a patient can go from here to here. We call this transformation the Lazarus Effect. It is the result of two pills a day taken by a HIV/AIDS patient for about 60 days. Learn more about how you can help give people the chance of life and joinred.com."The Lazarus Effect video, the (RED) Campaign.This Chapter explores how a number of non-government organizations, charities, and philanthropists have promoted ’grants' as a means of stimulating investment in research and development into neglected diseases. Each section considers the nature of the campaign; the use of intellectual property rights, such as trade marks; and the criticisms made of such endeavors. Section 2 looks at the (RED) Campaign, which is designed to boost corporate funding and consumer support for the Global Fund. Section 3 examines the role of the Gates Foundation in funding research and development in respect of infectious diseases. It explores the championing by Bill Gates of ’creative capitalism'. Section 4 considers the part of the Clinton Foundation in the debate over access to essential medicines. The Chapter concludes that, despite their qualities, such marketing initiatives fail to address the underlying inequalities and injustices of international patent law.

The importance of group-fit in new director selection

Purpose Director selection is an important yet under-researched topic. The purpose of this paper is to contribute to extant literature by gaining a greater understanding into how and why new board members are recruited. Design/methodology/approach This exploratory study uses in-depth interviews with Australian non-executive directors to identify what selection criteria are deemed most important when selecting new director candidates and how selection practices vary between organisations. Findings The findings indicate that appointments to the board are based on two key attributes: first, the candidates’ ability to contribute complementary skills and second, the candidates’ ability to work well with the existing board. Despite commonality in these broad criteria, board selection approaches vary considerably between organisations. As a result, some boards do not adequately assess both criteria when appointing a new director hence increasing the chance of a mis-fit between the position and the appointed director. Research limitations/implications The study highlights the importance of both individual technical capabilities and social compatibility in director selections. The authors introduce a new perspective through which future research may consider director selection: fit. Originality/value The in-depth analysis of the director selection process highlights some less obvious and more nuanced issues surrounding directors’ appointment to the board. Recurrent patterns indicate the need for both technical and social considerations. Hence the study is a first step in synthesising the current literature and illustrates the need for a multi-theoretical approach in future director selection research.

Integration over song classification replicates: song variant analysis in the hihi

Human expert analyses are commonly used in bioacoustic studies and can potentially limit the reproducibility of these results. In this paper, a machine learning method is presented to statistically classify avian vocalizations. Automated approaches were applied to isolate bird songs from long field recordings, assess song similarities, and classify songs into distinct variants. Because no positive controls were available to assess the true classification of variants, multiple replicates of automatic classification of song variants were analyzed to investigate clustering uncertainty. The automatic classifications were more similar to the expert classifications than expected by chance. Application of these methods demonstrated the presence of discrete song variants in an island population of the New Zealand hihi (Notiomystis cincta). The geographic patterns of song variation were then revealed by integrating over classification replicates. Because this automated approach considers variation in song variant classification, it reduces potential human bias and facilitates the reproducibility of the results.

Don't argue with the ref! - Legal liability for incorrect decisions of sports' officials

This paper continues the conversation from recent articles examining potential remedies available for incorrect decisions by sports officials. In particular, this article focuses on bringing an action against an official in negligence for pure economic loss. Using precedent cases, it determines that such an action would have a low chance of success, as a duty of care would be difficult to establish. Even if that could be overcome, an aggrieved player or team would still face further hurdles at the stages of breach, causation and defences. The article concludes by proposing some options to further reduce the small risk of liability to officials.

Ankylosing spondylitis in West Africans - evidence for a non-HLA-B27 protective effect

Objective - To determine the prevalence of ankylosing spondylitis in the Fula ethnic group in The Gambia, and relate the disease prevalence to the B27 frequency and subtype distribution of that population. Methods - 215 first degree relatives of 48 B27 positive Fula twin pairs, and 900 adult Fula males were screened for ankylosing spondylitis by clinical and, where appropriate, radiographic means. The B27 prevalence was determined by PCR/sequence specific oligonucleotides on finger prick samples from 100 unrelated Fula, and B27 subtype distribution by SSCP on unrelated B27 positive individuals. This data were then compared with the prevalence of ankylosing spondylitis among B27 positive Caucasians. Results - No case of ankylosing spondylitis was seen. Six per cent of Fula are B27 positive, of which 32% are B*2703 and 68% B*2705. Assuming the penetrance of ankylosing spondylitis in B27 positive Fula is the same as in B27 positive Caucasians, the probability of not observing any cases of ankylosing spondylitis among the Fula examined is remote (P = 6.7 x 10-6). Similarly, the chance of not seeing any cases among those expected to be either B*2705 or B*2703 was small (P = 3.2 x 10-4 for B*2705, and P = 0.02 for B*2703). Conclusions - The risk of developing ankylosing spondylitis in B27 positive Fula is lower than in B27 positive Caucasians. This is not explained by the B27 subtype distribution among Fula, and suggests the presence of some non-B27 protective factor reducing the prevalence of ankylosing spondylitis in this population.

Expectation and variation with a virtual die

By the time students reach the middle years they have experienced many chance activities based on dice. Common among these are rolling one die to explore the relationship of frequency and theoretical probability, and rolling two dice and summing the outcomes to consider their probabilities. Although dice may be considered overused by some, the advantage they offer is a familiar context within which to explore much more complex concepts. If the basic chance mechanism of the device is understood, it is possible to enter quickly into an arena of more complex concepts. This is what happened with a two hour activity engaged in by four classes of Grade 6 students in the same school. The activity targeted the concepts of variation and expectation. The teachers held extended discussions with their classes on variation and expectation at the beginning of the activity, with students contributing examples of the two concepts from their own experience. These notions are quite sophisticated for Grade 6, but the underlying concepts describe phenomena that students encounter every day. For example, time varies continuously; sporting results vary from game to game; the maximum temperature varies from day to day. However, there is an expectation about tomorrow’s maximum temperature based on the expert advice from the weather bureau. There may also be an expectation about a sporting result based on the participants’ previous results. It is this juxtaposition that makes life interesting. Variation hence describes the differences we see in phenomena around us. In a scenario displaying variation, expectation describes the effort to characterise or summarise the variation and perhaps make a prediction about the message arising from the scenario. The explicit purpose of the activity described here was to use the familiar scenario of rolling a die to expose these two concepts. Because the students had previously experienced rolling physical dice they knew instinctively about the variation that occurs across many rolls and about the theoretical expectation that each side should “come up” one-sixth of the time. They had observed the instances of the concepts in action, but had not consolidated the underlying terminology to describe it. As the two concepts are so fundamental to understanding statistics, we felt it would be useful to begin building in the familiar environment of rolling a die. Because hand-held dice limit the explorations students can undertake, the classes used the soft-ware TinkerPlots (Konold & Miller, 2011) to simulate rolling a die multiple times.

The ovarian response to controlled stimulation in IVF cycles may be predictive of the age at menopause

STUDY QUESTION Can the number of oocytes retrieved in IVF cycles be predictive of the age at menopause? SUMMARY ANSWER The number of retrieved oocytes can be used as an indirect assessment of the extent of ovarian reserve to provide information on the duration of the reproductive life span in women of different ages. WHAT IS KNOWN ALREADY Menopause is determined by the exhaustion of the ovarian follicular pool. Ovarian reserve is the main factor influencing ovarian response in IVF cycles. As a consequence the response to ovarian stimulation with the administration of gonadotrophins in IVF treatment may be informative about the age at menopause. STUDY DESIGN, SIZE, DURATION In the present cross-sectional study, participants were 1585 infertile women from an IVF clinic and 2635 menopausal women from a more general population. PARTICIPANTS/MATERIALS, SETTING, METHODS For all infertile women, the response to ovarian stimulation with gonadotrophins was recorded. For menopausal women, relevant demographic characteristics were available for the analysis. MAIN RESULTS AND THE ROLE OF CHANCE A cubic function described the relationship between mean numbers of oocytes and age, with all terms being statistically significant. From the estimated residual distribution of the actual number of oocytes about this mean, a distribution of the age when there would be no oocytes retrieved following ovarian stimulation was derived. This was compared with the distribution of the age at menopause from the menopausal women, showing that menopause occurred about a year later. LIMITATIONS, REASONS FOR CAUTION The retrieved oocyte data were from infertile women, while the menopausal ages were from a more general population. WIDER IMPLICATIONS OF THE FINDINGS In the present study, we have shown some similarity between the distributions of the age when no retrieved oocytes can be expected after ovarian stimulation and the age at menopause. For a given age, the lower the ovarian reserve, the lower the number of retrieved oocytes would be and the earlier the age that menopause would occur.

Traffic behaviour and compliance with the law in low and middle income countries: are we observing "pragmatic driving"?

A common theme in many accounts of road safety and road use in low and middle income countries is a widespread lack of compliance with traffic laws and related legislation. A key element of the success of road crash prevention strategies in high income countries has been the achievement of safer road user behaviour through compliance with traffic laws. Deterrence-based approaches such as speed cameras and random breath testing, which rely on drivers making an assessment that they are likely to be caught if they offend, have been very effective in this regard. However, the long term success of (for example) drink driving legislation has been supported by drivers adopting a moral approach to compliance rather than relying solely on the intensity of police operations. For low and middle income countries such morally based compliance is important, since levels of police resourcing are typically much lower than in Western countries. In the absence of morally based compliance, it is arguable that the patterns of behaviours observed in low and middle income countries can be described as "pragmatic driving": compliance only when there is a high chance of being detected and fined, or where a crash might occur. The potential characteristics of pragmatic driving in the macro-, meso- and micro-context of driving and the enforcement approach that could address it are outlined, with reference to the limited existing information available.

A randomized trial of fellowships for early career researchers finds a high reliability in funding decisions

Objectives Funding for early career researchers in Australia's largest medical research funding scheme is determined by a competitive peer-review process using a panel of four reviewers. The purpose of this experiment was to appraise the reliability of funding by duplicating applications that were considered by separate grant review panels. Study Design and Methods Sixty duplicate applications were considered by two independent grant review panels that were awarding funding for Australia's National Health and Medical Research Council. Panel members were blinded to which applications were included in the experiment and to whether it was the original or duplicate application. Scores were compared across panels using Bland–Altman plots to determine measures of agreement, including whether agreement would have impacted on actual funding. Results Twenty-three percent of the applicants were funded by both panels and 60 percent were not funded by both, giving an overall agreement of 83 percent [95% confidence interval (CI): 73%, 92%]. The chance-adjusted agreement was 0.75 (95% CI: 0.58, 0.92). Conclusion There was a comparatively high level of agreement when compared with other types of funding schemes. Further experimental research could be used to determine if this higher agreement is due to nature of the application, the composition of the assessment panel, or the characteristics of the applicants.

Survival, growth and quality of life in children after orthotopic liver transplantation: A 5 year experience

The aims of this study were to investigate outcome and to evaluate areas of potential ongoing concern after orthotopic liver transplantation (OLT) in children. Actuarial survival in relation to age and degree of undernutrition at the time of OLT was evaluated in 53 children (age 0.58-14.2 years) undergoing OLT for endstage liver disease. Follow-up studies of growth and quality of life were undertaken in those with a minimum follow-up period of 12 months (n = 26). The overall 3 year actuarial survival was 70%. Survival rates did not differ between age groups (actuarial 2 year survival for ages <1, 1-5 and >5 years were 70, 70 and 69% respectively) but did differ according to nutritional status at OLT (actuarial 2 year survival for children with Z scores for weight <-1 was 57%, >-1 was 95%; P = 0.004). Significant catch-up weight gain was observed by 18 months post-transplant, while height improved less rapidly. Quality of life (assessed by Vineland Adaptive Behaviour Scales incorporating socialization, daily living skills, communication and motor skills) was good (mean composite score 91 ± 19). All school-aged children except one were attending normal school. Two children had mild to moderate intellectual handicap related to post-operative intracerebral complications. Satisfactory long-term survival can be achieved after OLT in children regardless of age but the importance of pre-operative nutrition is emphasized. Survivors have an excellent chance of a good quality of life and of satisfactory catch-up weight gain and growth.